Diabetes Risk Factors Community Profile Cumberland County, NJ

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1 Diabetes Risk Factors Community Profile Cumberland County, NJ June 2014 Prepared By: The Directors of Health Promotion and Education

2 Table of Contents Target Population... 1 Location of People with Diabetes Risk Factors... 4 Marketing... 5 Maps... 7 Demographic and Socioeconomic Status Associated with Higher Risk of Diabetes... 8 Behaviors Associated with Higher Risk of Diabetes Understanding the Built Environment Large Employers Appendix 1: Project and Technical Notes Appendix 2: Enhanced Demographics... Click for Appendix Appendix 3: Target Concentration Reports... Click for Appendix Appendix 4: Media Profiles... Click for Appendix Appendix 5: Select Demographics by Zip Code... Click for Appendix Appendix 6.1: Behaviors Associated with Higher Risk of Diabetes by Zip Code.... Click for Appendix Appendix 6.2: Behaviors Associated with Higher Risk of Diabetes by Census Tract...Click for Appendix Appendix 7: List of Select Businesses... Click for Appendix Appendix 8: List of Large Businesses... Click for Appendix

3 This report is designed to provide the data and recommendations to identify: target audiences for the Diabetes Prevention Programs (DPP) how to reach the target audience health care facilities in the area that can refer to DPPs locations of select business that may be useful in promoting DPPs DPP is an evidence-based lifestyle change program for preventing type-2 diabetes. The program was designed by Centers for Disease Control and Prevent (CDC) program and sites that administer the program can go through a certification to become a certified DPP site. Target Population This report uses PRIZM segment descriptions to determine where people at risk for diabetes may be located. Each segment has unique demographic descriptions based on income, life stage, age range, presence of children in the household, home ownership, employment, education, and race and ethnicity; there are 66 PRIZM segments. Based on the segment profiles the following questions can be examined: Where is the target population located? How would you reach them? What else is in the area? Approximately 40,140 1 prediabetic adults 21 years old and older live in Cumberland County. Approximately 50% of adults 65 and older are estimated to have prediabetes. 1 People with prediabetes have an increased risk of developing type 2 diabetes, heart disease, and stroke. Studies have shown that people with prediabetes who lose weight and increase their physical activity can prevent or delay type 2 diabetes and in some cases return their blood glucose levels to normal. If the modifiable risk factors for type 2 diabetes (being overweight or obese and physical inactive) continue to increase, so will the prevalence of type 2 diabetes. The adult obesity prevalence in New Jersey increased from 14.5 to 24.8 percent between 1995 and Individuals at greatest risk of developing diabetes in are: African Americans Individuals with no college education Households that earn less than $25,000 per year Table 1 provides a summary of some of the demographic factors associated with a higher risk of developing diabetes. Appendix 2 contains a detailed report of demographics and household characteristics for the areas of interest. 1Estimate is based on multiplying the population for those 21 years old and older by 35%.The estimated number of persons with prediabetes was calculated by applying the national estimate of prediabetes from NHANES III to the 2013 population estimate for adults aged 21 years and older in the geography of interest. This is the same methodology as was used in the Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Available at: 2New Jersey Behavioral Risk Factor Surveillance System, Available at 1 P age

4 Table 1 Demographics Cumberland County New Jersey United States Total Population 158,416 8,906, ,199,353 Age < 21 years old 27.60% 26.64% 27.73% % 30.61% 31.56% % 28.11% 26.47% % 12.50% 12.35% % 2.14% 1.88% Race White 61.88% 67.13% 71.33% Black or African American 19.99% 13.74% 12.69% American Indian and Alaska Native 1.06% 0.35% 0.97% Asian 1.44% 8.83% 5.01% Native Hawaiian and Other Pacific Islander 0.04% 0.04% 0.18% Some Other Race 11.84% 6.88% 6.63% Two or More Races 3.76% 3.02% 3.18% Ethnicity Hispanic 28.78% 19.25% 17.55% Not Hispanic 71.22% 80.75% 82.45% Household Income Average $65,503 $94,023 $71,320 Median $52,791 $69,176 $51,579 Population 25 and older with less than a four-year college degree 85.02% 64.76% 71.61% Approximately one in four individuals in Cumberland County are between 45 and 64 years old. This age group is an ideal target group as the prevalence of diabetes goes up dramatically in the population 65 and older. 3 Compared to the state, Cumberland County has a lower median household income and higher percent of adults with less than a four-year college degree. This suggests that the population that lives in Cumberland County may be at greater risk of developing diabetes compared to the state as a whole. 3 New Jersey Behavioral Risk Factor Surveillance System, Available at 2 P age

5 Map 1 shows Cumberland County. There are several Federally Qualified Health Centers (FQHC) located in Cumberland County and one YMCA. 3 P age

6 Location of People with Diabetes Risk Factors The target population is individuals with risk factors for diabetes. The target population was determined using the demographic description and lifestyle preferences of each PRIZM segment found in Cumberland County. Segments with demographic characteristics associated with a higher prevalence of diabetes were combined to form a profile. The demographic and socioeconomic characteristics included are: Education Attainment: less than a four-year college degree Household Income: $50,000 or less per year Age: segment age ranges that overlapped or contained the age group of 45 to 84 year olds Based on these three characteristics the following PRIZM segments were found to be at high risk of developing diabetes: 38, 39, 40, 41, 44, 46, 47, 48, 49, 53, 55, 56, 57, 58, 59, 60, 61, 62. There are 66 PRIZM segments. In general, as the segment number increases, the socioeconomic status decreases. As mentioned previously, each segment has a unique demographic and socioeconomic description based on several indicators including income, life stage, age range, presence of kids in the household, home ownership, employment, education, and race and ethnicity. For a detailed description of each segment, visit To verify that these segments also had high-risk lifestyle behaviors that could lead to diabetes additional analyses examined their likelihood of being physically active, consuming fruits and vegetables, and watching over 20 hours of television per week. It was found that these segments were among the least likely to be physically active and to consume fruits and vegetables, and among the most likely to watch more than 20 hours of television per week. Map 2.1 shows the concentration of the target segments within each zip code in Cumberland County and Map 2.2 shows the concentration within each census tract; the dark blue area have a higher the concentration of the target segments. Appendix 3 provides a list of all the zip codes and census tracts in Cumberland County and the number of households that are at high risk of developing diabetes. The zip codes within Cumberland County where 25% or more households have one or more adults that fit this profile are 08345, 08332, 08360, 08349, and Taking a closer look at the census tracts in these areas may help narrow the focus highest risk areas further. The three census tracts with the highest concentration of the target population are located in the middle of Bridgeton, Millville and Vineland. 4 P age

7 Marketing 4 Below are ways to reach your target audience. There are descriptions of how often and the types of print, radio, and television stations they read, listen to, and watch. For radio and television, the times and days of the week the audience is most likely to listen to or watch are listed as well. See Appendix 4 for detailed tables and the source of the information on which the descriptions below are based. The majority of findings are based on the number of adults per 100 households. For these findings, it is possible to have more than 100 adults per 100 households as multiple adults can live in a household. A few of the findings are based on household consumption, for these findings the number of households cannot exceed 100. Print Media Profile: Among the segments at high risk for diabetes that live in Cumberland County: Over 50 adults per 100 households in the target PRIZM segments read the Sunday newspaper, general editorials, women s magazines, and news weekly magazines. Approximately the 84 adults per 100 households report frequently reading the newspaper; however, 77 adults per 100 households report reading the newspaper infrequently. Approximately 72 adults per 100 households report reading the Sunday newspaper and 60 adults per 100 households report reading the daily newspaper. If using print media as a method for reaching the target population, the Sunday newspaper has the most reach. Radio Media Profile: Among the segments at high risk for diabetes that live in Cumberland County: Approximately 93 adults per 100 households listen to the radio less than 20 hours a week; however, 68 adults per 100 households listen to the radio more than 20 hours a week. The highest number of adults per 100 households listens to the radio Monday through Friday from 6 a.m. to 10 a.m., and Saturday and Sunday from 10 a.m. to 3 p.m. The most frequently listened to radio stations are country radio stations If using radio media as a method for reaching the target population, the best time of day is 6 a.m. to 10 a.m. Monday through Friday on country radio stations. 4 Marketing Profile is based on the PRIZM segments that are least likely to report exercising: segments 38, 39, 40, 41, 44, 46, 47, 48, 49, 53, 55, 56, 57, 58, 59, 60, 61, 62. There are 66 PRIZM segments the higher the number the lower the socialeconomic status. The segments are defined based on a combination of household characteristics (e.g., presence of kids), demographic characteristics, and economic characteristics. Nielsen s segmentation system has been tested and verified in various settings and geographic locations. The selected marketing avenues were selected based on both a high Market Potential Index as well as the number of people that could be reached. 5 P age

8 Television Media Profile: Note this profile captures usage of specific channels if you want to know the shows watched or frequency of viewing different shows, let DHPE know and additional analysis can be run. Among the segments at high risk for diabetes that live in Cumberland County: Over 105 adults per 100 households watch 20 hours or more of television per week. Over 80 adults per 100 households average at least a half hour of television between 8 p.m. and 11 p.m., 7:30 p.m. and 8 p.m., and 7 p.m.-7:30 p.m. Monday through Friday. Weekend viewing during these times is also around 80 adults per 100 households. Approximately 76% of households subscribe to cable or satellite television. If using television media as a method for reaching the target population, the best time of day is 7 p.m p.m. Monday through Friday. Internet Media Profile: Among the segments at high risk for diabetes that live in Cumberland County: Over 110 adults per 100 households use the internet 0 to 17 times per month. Approximately 58% own their own computer. Approximately 20 adults per 100 households use the internet frequently 28 or more times per month. Approximately 25 adults per 100 households use the internet via a cell phone or smart phone, and 37 adults per 100 households visited friends profile pages on social networking sites. Internet use for most adults in the target segments is low compared to the general population. Attitude Towards Media: Over 50 users per 100 households in the target population feel magazines, newspapers, radio, and television ads give useful information. The target segments are more likely to agree that television is the most trusted media. Grocery Shopping Habits Over 88 users per 100 households in the target segments grocery shop at a Walmart Supercenter or similar store (e.g. Target Super Store). Approximately 45 users per 100 households in the target segments do their grocery shopping within two miles of their home. Retailer and Shopping Habits: Walmart appears to be the store that the target segments shop at most often. Maps The following maps may be useful in program planning efforts to identify potential target areas. Maps 3.1 through 8.3 highlight geographic areas with demographic and socioeconomic status data 6 P age

9 that are associated with a higher risk of developing diabetes. Maps 9.1 through 12.2 highlights geographic areas where health behaviors are exhibited that are associated with higher risk of developing diabetes. Appendix 5 contains the demographic and socioeconomic status data provided in Maps 3.1 through 8.3. Appendix contains the health behavior data provided in Maps 9.1 through P age

10 Demographic and Socioeconomic Status Associated with Higher Risk of Diabetes Map 3.1 shows the percent of families living below poverty by zip code. The zip codes in red have the highest percent of families living below poverty -- between 12.0% and 15.5%. At least 10% of the families in the following zip codes are below poverty: 08349, 08332, 08302, and Map 3.2 shows the percent of families living below poverty by census tract. Map 3.3 shows the number of families living below poverty. 8 P age

11 Map 4.1 shows the average annual household income and percent of adults 25 and older who have less than a fouryear college degree by zip code. The areas with the darkest bluish-green color have the lowest average household income, and the areas with the darkest lines have the highest percent of adults without a four-year college degree. The following zip codes had average household income less than $60,000 per year: and At least 85% of adults 25 years old and older have less than a four-year college degree in the following zip codes: 08314, 08345, 08311, 08360, 08349, 08302, and Map 4.2 shows the average annual household income and percent of adults 25 who have less than a four-year college census tract. and older degree by 9 P age

12 Map 5.1 shows the percent of the population that is Hispanic by zip code. As the blue color darkens, the percent of the population that is Hispanic increases. At least 30% of the population is Hispanic in the following zip codes: 08360and Nationally, Hispanics have a higher risk of developing diabetes. Map 5.2 shows the percent of the population that is Hispanic by census tract. Map 5.3 shows the number of Hispanics. 10 P age

13 Map 6.1 shows the percent of the population that is African American by zip code. As the red color darkens, the percent of the population that is, African American increases. At least 20% of the population is African American in the following zip codes: 08314, 08302, and Map 6.2 shows the percent of the population that is African American by census tract. Map 6.3 shows the number of African Americans. 11 P age

14 Map 7.1 shows the percent of the population 45 through 64 years old by zip code. As the orange color darkens, the percent of the population that is between 45 and 64 years old increases. At least 33% of the population is 45 to 64 years in the following zip codes: 08323, 08340, 08270, and Map 7.2 shows the percent of the population 45 through 64 years old by census tract. Map 7.3 shows the number of adults 45 through 64 years old. 12 P age

15 Map 8.1 shows the percent of the population 65 years old and older by zip code. As the orange color darkens, the percent of the population that is 65 years old and older increases. At least 20% of the population is 65 years old and older in the following: and Map 8.2 shows the percent of the population 65 years old and older by census tract. Map 8.3 shows the number of adults 65 years old and older. 13 P age

16 Behaviors Associated with Higher Risk of Diabetes Maps 9.1 and 9.2 show the average number of pounds of fresh fruits and vegetables per month per household. The darker the green, the fewer pounds of fresh fruits and vegetables consumed. Based on results from the Behavioral Risk Factor Surveillance System (BRFSS) most adults do not eat the recommended number of servings of fruits and vegetables. On average only 1 in 4 adults, consume five or more fruits and vegetables per day. 5 5 New Jersey Behavioral Risk Factor Surveillance System, Available at 14 P age

17 Maps 10.1 and 10.2 show the average number of glasses of regular cola consumed per week among adults. The darker the blue, the more cola consumed per week. 15 P age

18 Maps 11.1 and 11.2 show the average number of times adults bought food at a fast food restaurant in a month. The darker the red, the more frequently adults purchased fast food. 16 P age

19 Maps 12.1 and 12.2 show the likelihood that adults exercise two or more times per week at home compared to the average adults in Cumberland County. The darker the orange, the less likely adults are to exercise two or more times per week at home. Market Potential Index (MPI) is calculated based on the number of users per 100 households in each zip code or census tract divided by the number of users per 100 households in the geographic area of interest times 100. It indicates the likelihood that households in a zip code or census tract are to display the behavior of interest, compared to the average for the geography of interest. An MPI of less than 100 indicates they are less likely to display the behavior of interest. An MPI greater than 100 indicates they are more likely to display the behavior of interest. The behavior of interest in Maps 12.1 and 12.2 is exercising two or more times per week and the geography of interest is Cumberland County. The adults that live in the dark orange zip codes are 1 to 13 percent less likely to exercise at home two or more times per week as compared to the average adult in Cumberland County, and adults that live in the light orange zip codes are 14 to 45 percent more likely to exercise at home two or more times per week compared to the average adult in Cumberland County. The adults that live in the dark orange census tracts are 15 to 100 percent less likely to exercise at home two or more times per week as compared to the average adult in Cumberland County. Adults that live in the light orange zip codes are 17 to 42 percent more likely to exercise at home two or more times per week as compared to the average adult in Cumberland County. 17 P age

20 Maps 13.1 and 13.2 show the likelihood that adults watch 45 or more hours of television per week compared to the average adults in Cumberland County. Adults that live in the pinkish red areas are more likely to watch 45 or more hours of television per week. Market Potential Index (MPI) is calculated based on the number of users per 100 households in each zip code or census tract divided by the number of users per 100 households in the geographic area of interest times 100. It indicates the likelihood that households in a zip code or census tract are to display the behavior of interest, compared to the average for the geography of interest. An MPI of less than 100 indicates they are less likely to display the behavior of interest. An MPI greater than 100 indicates they are more likely to display the behavior of interest. The behavior of interest in Maps 13.1 and 13.2 is watching 45 or more hours of television per week and the geography of interest is Cumberland County. The adults that live in the pinkish red zip codes are 4 to 24 percent more likely to watch 45 or more hours of television per week as compared to the average adult in Cumberland County, and adults that live in the blue zip codes are 1 to 33 percent less likely to watch 45 or more hours of television per week compared to the average adult in Cumberland County. The adults that live in the pinkish red census tracts are 11 to 28 percent more likely to watch 45 or more hours of television per week as compared to the average adult in Cumberland County. Adults that live in the blue zip codes are less likely to watch 45 or more hours of television per week as compared to the average adult in Cumberland County. 18 P age

21 Understanding the Built Environment Table 2 below provides a list of the number of certain types of businesses located in Cumberland County. The North American Industry Classification System (NAICS) codes were used to identify businesses. The following NAICS codes were used: Medical Offices (except Mental Health Specialist) Convenience food stores Gasoline stations with convenience stores Grocery stores Churches Restaurants Coffee shops Beauty Salons Elementary and Secondary Schools Fitness Centers Senior Centers Appendix 7 provides a list of each of these types of businesses that are in Cumberland County. Table 2. Number of Select Types of Businesses within the Cumberland County Number of Businesses Medical Offices (except Mental Health 194 Specialist)* Federally Qualified Health Centers ǂ 17 Grocery Stores 54 Churches 325 Elementary and Secondary Schools includes School Administration Building locations 102 YMCA 1 Fitness Centers 17 Senior Centers 7 * This includes dermatologists, cardiologist, and other specialty offices in addition to primary care offices. Due to changes in coding, it is not easy to separate the type of medical office based on the NAICS codes. Also medical offices are listed multiple times because each provider can register themselves as a business. Attempts were made to de-duplicate the number based on the street address. However, all listings are provided in Appendix 7. ǂ Health Resource and Service Administration Data Warehouse Accessed March 8, P age

22 Large Employers Table 3 below provides a list of business that have 500 or more employees within Cumberland County. Businesses with multiple locations may have registered the number of employees for each location or the number for all locations. (e.g., McDonald's might say it has 10,000 employees because all locations combined have 10,000). Appendix 8 provides a list of all businesses, large employers, and business with multiple locations. The business lists may contain the same business multiple times for several reasons: 1) they have multiple locations, 2) different spellings of the same business were registered with the same address, 3) the business is registered under more than one NASIC code, or 4) it was registered with the same name more than once or with a different employee size. Table 3. Large Employers within Cumberland County Company Name Address City/State Zip Code STATE PRISON 4293 ROUTE 47 Leesburg, NJ SOUTHERN STATE CORRECTIONAL 4295 ROUTE 47 Delmont, NJ CUMBERLAND COUNTY FAMILY PART BROAD & FAYETTE Bridgeton, NJ SJH BRIDGETON HEALTH CTR 333 IRVING AVE Bridgeton, NJ SOUTHWOODS STATE PRISON 215 S BURLINGTON RD Bridgeton, NJ DURAND GLASS MFG CO 901 S WADE BLVD Millville, NJ GERRESHEIMER GLASS INC 537 CRYSTAL AVE Vineland, NJ VINELAND DEVELOPMENT CTR 1676 E LANDIS AVE Vineland, NJ TRAINING SCHOOL AT VINELAND 1667 E LANDIS AVE Vineland, NJ VINELAND CITY HALL 640 E WOOD ST Vineland, NJ WALMART SUPERCENTER 1070 W LANDIS AVE Vineland, NJ P age

23 Appendix 1: Project and Technical Notes: Behavioral Risk Factor Surveillance System (BRFSS) is a primary source of diabetes data at the county and state level for local health departments and other agencies. Through a grant award, the Directors of Health Promotion and Education (DHPE) are able to offer data and analysis at smaller units of geography through a database maintained by the Nielsen Company. Under the grant, DHPE is able to provide these data to ten state health departments, District of Columbia Health Department, and a tribal organization. State and local health departments not funded through the grant, as well as nonprofit organizations, can contact DHPE if they are interested in these data. Technical Background Nielsen is a global marketing and advertising research company that offers software to businesses and government agencies through two software programs: ConsumerPoint and PrimeLocation. Nielsen is one of the world s leading suppliers of marketing information, media information and TV ratings, online intelligence, and mobile measurement. Nielsen PRIZM Segments Community populations are categorized into 66 segments based on socioeconomic rank, life stage, and urbanization. The 66 segments each have unique demographic descriptions based on income, age class, age range, presence of kids in the household, home ownership, employment, education, and race and ethnicity. Each segment also has specific lifestyle preferences that are typical for the segment such as media preferences, shopping preferences, and typical behaviors. More information may be accessed at the following site: ook-up Appendix 2: Enhanced Demographics Due to the length of this appendix, it is in a separate accompanying document. This appendix contains detailed demographics and socioeconomic characteristics beyond those provided in Table 1. Appendix 3: Target Concentration Reports There are approximately 51,966 households in Cumberland County. Of these approximately 13,822 households (or 27%), have one or more members who are at high risk of developing prediabetes. Due to the length of this appendix, it is in a separate accompanying document. The information in this appendix was used create Maps 2.1 and P age

24 Appendix 4: Media Profiles Media profiles were conducted for the target area of interest using PRIZM household segments that have characteristics associated with a higher risk of developing prediabetes and diabetes as the target population. For this report, the geography of interest is Cumberland County. Due to the length of this appendix, it is in a separate accompanying document. The information in this appendix was used create the marketing descriptions provided in the Marketing section of this report. Appendix 5: Select Demographics by Zip Code Due to the length of this appendix, it is in a separate accompanying document. This information in this appendix was used in the creation of Maps 3 through 8. Appendix 6.1: Behaviors Associated with Higher Risk of Diabetes by Zip Code Due to the length of this appendix, it is in a separate accompanying document. The information in this appendix was used create Maps 9 through 13. Appendix 6.2: Behaviors Associated with Higher Risk of Diabetes by Census Tract Due to the length of this appendix, it is in a separate accompanying document. The information in this appendix was used create Maps 9 through 13. Appendix 7: List of Select Businesses Due to the length of this appendix, it is in a separate accompanying document. The information in this appendix was used to estimate the number of business in Table 2. Appendix 8: Large and Multi Site Businesses Due to the length of this appendix, it is in a separate accompanying document. The information in this appendix was used to develop the large employer list in Table P age

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